McGill-Toolen Catholic High School

Athletic Department

Parents:

State regulations require that each participant in any school athletic program be covered by adequate insurance and have a current physical on file at school. If you already have a physical form completed, please complete and return this form to your coach or moderator.

If you wish for your child to participate in the sports program, off season workouts, and summer conditioning and drills at McGill-Toolen Catholic High school, please fill out information below.

I hereby give my child:

Last ______First______MI____

Address: ______

City______State __AL_Zip______

Home Phone ______Work Phone______Cell______

Emergency Contact______Relationship______

Home Phone______Work Phone______Cell______

To participate in the following sports and conditioning programs at McGill Toolen Catholic High School I understand the potential of catastrophic injury. I also understand the importance of rues and procedures, as well as, the necessity of using proper techniques.

Please check all sports in which your child has permission to participate:

( ) Football ( ) Volleyball ( ) Cross Country ( )Basketball ( ) Track ( ) Soccer

( ) Tennis ( ) Baseball ( ) Cheerleader ( ) Softball ( ) Golf( ) Swimming/Diving

Signature of Parent ______Date ______

Note: Any retraction of permission to participate in the sports program at McGill Toolen Catholic High school should be submitted in writing.

I further assume all medical responsibilities in case my child receives an injury. My signature below relieves McGill -Toolen Catholic High School of all Medical responsibilities. I also give permission for my son/daughter to be given over the counter medications in accordance with directions on the package.

The student athlete has adequate insurance coverage by:

Name on insurance card: Last______First ______MI______

Name of Insurance Company______Policy #______Group #______

Insurance Address: Street______City______Zip______Phone#______

Relationship______Phone#______

I give my permission for the athletic trainer to inform the coaching staff or administrative staff at McGill- Toolen Catholic High School of any injuries resulting from athletic participation. I authorize thee school staff to transport my child to a doctor’s appointment in the event I can not take them. In the event of an emergency, I give my permission to seek medical/dental attention for my son/daughter. Please circle one: Yes No

Name of family physician:______Phone #______

Name of orthopedic physician:______Phone #______

______

Signature of Parent DateSignature of Student